Eye Signs of Systemic Disease: Case 6 Diabetic Maculopathy

During an annual eye examination, a 65-year-old womanwith a 5-year history of type 2 insulin-dependent diabetescomplained that her vision had slightly worsened in botheyes. Her best corrected visual acuity was 20/30 in botheyes.Ophthalmoscopic examination revealed nonproliferativediabetic retinopathy changes, including dot-blot hemorrhagesthat originated in the middle layers of the retina.Areas of yellow, waxy, hard exudates composed of lipoproteinand lipid-filled macrophages were seen formingclumps and circinate rings adjacent to and involving themacula. Stereoscopic examination of the macula confirmedmacular thickening. No cotton-wool spots or areas of neovascularizationwere noted (A and B).Diabetic maculopathy was confirmed by a fluoresceinangiogram, which revealed leaking microaneurysms thatcaused the retinal thickening and the hard exudates. Afocal argon laser treatment was performed in each eye toresolve the macular edema, encourage resorption of leakedfluid, and treat leaking vessels and microaneurysms to preventfurther leakage.Laser treatment for clinically significant macularedema is recommended if one or more of the followingfindings is present:

• Retinal edema (thickening) within 500 m of the centerof the fovea.
• Hard exudates within 500 m of the fovea, if associatedwith adjacent retinal thickening (which may be outsidethe 500-m limit).
• Retinal edema that is 1 disc area (1500 m) or larger, anypart of which is within 1 disc diameter of the center of thefovea.¹
• This patient required only a single laser treatment.Additional treatments can be given if complete resorptionis not achieved after 2 to 3 months.